Provider Demographics
NPI:1821712589
Name:INOVA SMILE
Entity Type:Organization
Organization Name:INOVA SMILE
Other - Org Name:INOVA SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-364-6682
Mailing Address - Street 1:1698 DIANE TER
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-4530
Mailing Address - Country:US
Mailing Address - Phone:321-366-9377
Mailing Address - Fax:
Practice Address - Street 1:3280 GREENWALD WAY N
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0728
Practice Address - Country:US
Practice Address - Phone:866-364-6682
Practice Address - Fax:866-716-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty